Impact case study database

Particle accelerators are wide-ranging in their applications and indispensable for society: They are at the heart of cancer treatment, and drive forward the frontiers of fundamental scientific knowledge. However, public understanding of the technology and awareness of UK research remains low. The University of Liverpool, together with the Cockcroft Institute and partners, is a hotbed of world-class accelerator science research. As coordinator of four large international research and training networks and a key contributor to major European accelerator R&D projects, the QUASAR Group is in a unique position to communicate globally its interdisciplinary research results, as well as the importance of accelerator science in society.

Since August 2013, a strategic outreach and public engagement programme based on the Group’s research has inspired and educated audiences from diverse backgrounds across the UK, Europe, Asia and the Americas; improved awareness of accelerator science in new and underrepresented groups; enthused young people to engage in science; supported public debate, and communicated accelerator science to industry. A range of tactics were used to great effect: workshops, events, teaching resources, films, media relations.

Tactile Collider - an immersive workshop for visually impaired (VI) children co-created and delivered by Dr Edmonds - has revolutionized the way they learn about accelerators by using soundscapes and specially developed tactile objects to make the physics accessible.

There are around 5,500 VI children in England and Wales aged 12-18. Since 2017, Tactile Collider has reached around 30% of them, directly engaging 286 children and through training of 124 specialist teachers in the Tactile Collider material extending its impact by an estimated further 1,300 VI children. When participants were asked about the impact of the workshop, 50% reported increased confidence talking about physics, 73% said they’d learned something new, and 69% felt inspired to learn more [5.2].

In 2019, Tactile Collider was awarded the European Physical Society’s HEPP Outreach Prize for “outstanding outreach achievement as a unique project” and the Royal National Institute of Blind People (RNIB) See Differently Award for Innovator of the Year [5.1].

International media coverage endorsed quality, e.g. Symmetry Magazine and CERN Courier, radio appearances on In Touch on BBC Radio 4 and a monthly podcast on RNIB Connect Radio since 2019 [5.2]. To raise public awareness of the challenges that affect people with VI and to promote the concept to wider audiences, Tactile Collider was invited to demonstrate at major international cultural and science events, including BlueDot Festival (2017, 2018), Africa Oyé (2018), North West Big Bang (2018, 2019) and CERN Open Days (2019) [5.2].

Prof Welsch and his Group designed, organized and delivered four large-scale science outreach symposia, three ‘Physics of Star Wars’ events, and eight ‘Accelerator Experience Days’ in the North-West of England. All events were based on Liverpool’s accelerator science research, featured engaging talks and hands-on demonstrations that explained Liverpool research, promoted interaction with scientists and sparked global media interest.

The Ogden Trust’s CEO found “The innovative combination of in-person attendance, online streaming and additional media activity has given these events an exceptionally wide reach and created impressive impact. In addition, teachers reported positive changes in attitudes to pursuing physics further, both at university and beyond.” [5.3]

Outreach symposia engaged a total of 893 high school and college students and 81 teachers from Liverpool City Region in 2015, 2018 and in March and June 2019 in the Arena and Convention Centre. The March 2019 event welcomed almost 1,000 participants, including high school students and their teachers, undergraduate students, scientists and industry, making it one of the largest accelerator science events ever held in England. High profile speakers including former CERN Director of Accelerators, Prof Steve Myers, and EPS Outreach Prize winner Dr Kate Shaw gave live-streamed talks about projects the Group is involved in.

• Symposia engaged pupils and teachers with the Group’s research and improved their interest in science: “Accelerators are involved in everyday life and students don’t know about that. We’ve come away feeling inspired and excited about physics,” said Mossland’s STEM Coordinator after the 2018 symposium. Another teacher said: “The symposium also offered a good way for me to gain experience and continuing professional development” [5.2].

• March 2019 symposium was the first-ever VI-inclusive accelerator science event by including Tactile Collider and using a narrator who explained all visual content via Bluetooth headsets to 14 VI young people. “A lot of people can feel daunted by particle physics, but it is possible to make complex ideas accessible and the kids come away feeling like they’ve achieved something”, said a science teacher of VI pupils attending the symposium [5.2].

• New industry audiences engaged through repeat sector-specific media coverage about the symposia, e.g. Laboratory News, E&T Magazine, Science Business, Technology Networks, AZO Optics [5.4]. New Electronics editor found: “The blend of science and its application in these articles has helped to widen access to information about accelerators as a key underpinning technology for industry and society. (...) Professor Welsch is my ‘go to’ person for opinions and in-depth information about this fascinating subject.“ [5.5]

• New 3M EUR Future Circular Collider Innovation Study, coordinated by CERN, highlighted the March 2019 symposium as an exemplary event for community engagement [5.6].

Physics of Star Wars events, developed by Prof Welsch and delivered annually 2017-2019, use the iconic films to explain applications of his accelerator R&D to science, society and commerce, improving public awareness and understanding of this technology. They inspired 323 secondary pupils, 22 teachers, 356 members of the public [5.2] and millions via media coverage [5.4].

• Impact is shown through positive feedback from pupils and teachers: “We had a fantastic time – there are a number of students who’ve been enthused to consider physics at degree level in the future”, said the Head of Science at Heath School [5.2].

• Interest in science was improved: "I was extremely impressed… being from a single sex (girls) school it is vital that our pupils are able to visualize themselves in STEM subjects,” said a physics teacher at Prenton High School for Girls. “Our pupils talked about their experience with others within their peer group; many pupils from the year group came to ask when it could be run again so they could attend!” The headteacher from St Gregory’s High School added that the events “enhance[d] interest in particular accelerators and the role of CERN (...) They are a magnificent way of not only improving learning but also to build bridges with Liverpool University and raising aspirations.” [5.2]

• Significance is further evidenced through subsequent invitations to deliver ‘Physics of Star Wars’ for example at Manchester Science and Industry Museum’s Science Late, Daresbury Lab’s Talking Science, Lymm summer festival, and at Barnsley Museums.[5.2]

• The events created awareness about Liverpool accelerator research around the world through multiple appearances in local TV; UK and US radio stations; national and international press, including Cordis (EU), BBC Science Focus, Total Film and New Electronics (UK), Frankfurter Rundschau (Germany), Gazete Duvar (Turkey), La Nacion (Argentina), National Interest Magazine (USA) [5.4].

Accelerator Experience Days , held by the Group in 2016 and 2017 to inspire young people to consider a career in STEM, engaged 277 year 9 and 10 secondary school children and 22 school teachers from across North West England with Liverpool’s research [5.2]. Impact is demonstrated through feedback, re-use of resources, media coverage, invitations to speak.

• Over 97% of the school children found the workshops ‘informative’ and 93% ‘interesting’. “I have learned about magnetic fields, antimatter, electric forces and energy, as well as particles and matter. I really saw the fun side of science and felt eager to learn more and try new things.”, “They (the experiments) made me more interested in physics.”, commented pupils who attended the workshops [5.2].

• “*These workshops gave students an important opportunity to learn about the practical applications of particle accelerators in society, while testing their experimental skills.*” commented the STFC magazine Fascination [5.2].

• Videos of experiments and explanations of the setups used in the workshops have created an educational resource for pupils and teachers with 67,012 views and 92.5% positive rating on YouTube (5/11/2020) [5.7].

• Quality is evidenced through invitations to present novel approach e.g. in BBC Radio Manchester and IOP’s Interact symposium (2017); re-use of setups developed for the workshops at other events, including “Coder Dojo” at Beamont Collegiate Academy (2017) and “Small particles, big machines” exhibition in Berlin (2017). [5.2]

Science education was enhanced more widely by publishing the educational videos, teaching resources and material from Liverpool’s outreach events to explain accelerator R&D in teaching magazines such as Science in School, Education Technology, and Teaching Times [5.4]. These have provided “an additional reference point for further reading for both pupils and staff.”, said a teacher from Warrington [5.2].

Resources also included acceleratAR, an augmented reality app developed by Dr Edmonds that uses paper cubes to create a virtual accelerator that helps students to learn about accelerator science. The app has been downloaded almost 5,000 times since February 2019 [5.2] and has received excellent reviews from scientific press and was listed as favourite science app by BBC Focus and Popular Science [5.2].

The quality of our educational material is further evidenced by feedback from the publisher of Teaching Times: “We would be very interested in getting more articles of the same sort in the future. It was great the way the article linked serious science with popular culture.” [5.2].

Prof Welsch has co-created four critically acclaimed short films about antimatter ‘ AVA - Nature (anti)matters’ and collider facilities ‘ Future Circular Collider’, ‘ Science knows no Borders’ and their applications ‘ Busy bees and mighty magnets’ with CERN (2018-2019) to showcase accelerator R&D at Liverpool and its partners. The films feature Prof Welsch, other Liverpool staff and Liverpool University campus, as well as collaboration partners, Nobel Laureate Peter Higgs and former CERN Director-General Rolf-Dieter Heuer. Reach and significance is demonstrated through awards, views, feedback, third party endorsement, and re-use:

• Awards: ‘Future Circular Collider’ - 2020 w3 Silver Award; ‘Science knows no Borders’ - shortlisted for 2019 EVCOM Award [5.1].

• ‘AVA - Nature (anti)matters’ selected by EU as excellent communication practice, shown to 232 coordinators and managers from 147 networks in 2018 ITN Coordinator’s meeting [5.7].

• 647,905 total views (5/11/2020), positive rating of 98% from 6.318 engagements [5.7].

• ‘AVA - Nature (anti)matters’ was the most viewed film out of 380 projects on the EU’s official science short film playlist [5.7].

• Social media re-posts, positive comments and endorsements from science influencers such as Professors Jim Al-Khalili “very inspirational” and Brian Cox “this is brilliant!” [5.7].

• Widely shown at major science events: FCC Week (Amsterdam 2018, Brussels 2019), Der Code des Universums (Vienna, 2018), as well as by the Royal Institution (London, 2019), and learned societies such as the IOP.

• Supporting global debate about the future of high energy colliders: Video snippets and imagery of “Future Circular Collider” re-used by media outlets in the UK, Germany and USA, including BBC, NBC, Guardian, Nature, London Science Museum and leading science portal Seeker, reaching over 1 million people through film, online and print media [5.4], [5.7].

Nature Physics chief editor described ‘Future Circular Collider’ as “clear, engaging and inspiring [that] has been used across different media platforms during a global public debate” [5.8].

The Group worked with mainstream and scientific media on stories for science-engaged and general audiences in the UK, Europe and the Americas e.g. ‘ Plugging the skills gap’; ‘ What’s the (anti)matter?’; ‘ What have particle accelerators ever done for us?’; ‘Do you want to boldly go where science has not gone before?’. Coverage by BBC Radio 5 Live, BBC’s Naked Scientists, The Times, Times Higher Education and New Statesman (UK), IFL Science (USA), Horizon Magazine and EU Research Magazine (EU), Die Welt (Germany), and BBC Mundo (Spanish-speaking world) improved awareness of Liverpool’s accelerator R&D and the projects the group is involved in for broad, media-engaged public [5.4].

Articles in scientific and technology press for science-inclined public, including Scientific American (USA), New Scientist, New Electronics, BBC Science Focus, Laboratory News, Physics World, UKSPA Magazine, Materials World, Haynes Manual - LHC (UK), Science (EU), and CERN Courier deepened knowledge about the Group’s technology developments [5.4].

Success is evidenced through invited talks about accelerator R&D at events outside academia, including IET workshops (2016, 2018); Lab Innovations - the UK's largest annual exhibition for the laboratory industry - (2018); International Festival for Business (2016). The curator at Lab Innovations said: “There were not many accelerator scientists at the show, everyone that heard Carsten speak will now absolutely be aware of the wide variety of different applications... especially in the medical field.“ [5.9] Quality in stimulating public interest in accelerator R&D is demonstrated by Prof Welsch being appointed as communication lead for the Cockcroft Institute (since 2015), the EU Design Studies EuroCirCol (coordinated by CERN) and EuPRAXIA (coordinated by DESY).

The significant impact of Liverpool’s public engagement has been recognised by invitations to speak about the communication activities at international events including ESOF (2014), Europe’s largest interdisciplinary meeting on science and innovation, and UKRO national training days (2017) [5.2].

Formal project evaluations have commended the communication and outreach as “ exemplary” and “outstanding in disseminating project results to the general public”. The Cockcroft Institute’s external Advisory Committee found in its 2018 report that the “communication initiatives continue to be impressive and exceptional” and highlighted them as “world-leading”. The European Commission has identified the accelerator science communication as a “success story” and invited Prof Welsch to present his approach in Brussels to project coordinators from across Europe [5.6].

To guarantee sustainability of the Group’s public engagement activities, the Fellows in Liverpool’s accelerator training networks and the Group’s staff and PhD students followed a science communication training programme developed by Prof Welsch. This created more than 100 accelerator science ambassadors, engaging with schools and the public around the world, including India, Mexico, Ukraine and all across the EU, consulting ministries in their home country about accelerator science, creating innovative social media platforms and blogs [5.2]. They continue to help raise awareness about accelerator research and Liverpool’s projects on a global scale.

Prof Shears has engaged audiences worldwide with Liverpool University’s LHCb particle physics research through art, philosophical debates, and international media. Impacts include:

• influenced artistic practice and co-developed a touring Arts at CERN art exhibition;

• shaped public debate and stimulated public interest in particle physics research through ‘ the world’s largest philosophy and music festival’, a Radio 4 debate and a BBC documentary;

• created awareness and improved public understanding of LHCb research discoveries through media work that “ reached audiences of many tens of millions of people” worldwide.

4.1 Influenced artistic practice and co-developed an international Arts at CERN exhibition

Recognising the power of art in communicating abstract concepts and complex ideas, such as those found in particle physics research, Shears has been involved with international art projects through Arts at CERN since its foundation in 2009. Between 2016 and 2018, Shears played a key role in Collide International – “ a flagship foundational program for Arts at CERN” that involved Shears’ LHCb research group at Liverpool and FACT (Foundation for Art and Creative Technology) [5.1]. “ It’s vitally important that we have scientists at CERN like Prof Shears who strongly believe that interactions with artists are very useful,” says Head of Arts at CERN [5.1].

Collide International provided ten successful artists - from countries including South Korea, Colombia, and Finland - with a two-month residency at CERN to immerse themselves in particle physics research, and a one-month residency at FACT to explore ways of realising their work [5.2a]. “ *Prof Shears was involved from the very beginning of the Collide International collaboration. In fact, she was involved before this project as a scientific partner for Arts at CERN. So, when we decided to take up this collaboration with Liverpool, it was clear that involving Prof Shears was going to be very valuable for us,*” [5.1] says Head of Arts at CERN. The Collide International award is highly competitive and judged by a panel of leading gallery curators, commissioners, and scientists including Shears [5.1, 5.2a]. “ We are passionate about staying true to the science and facts that inspire artists. Prof Shears contributed greatly … to help us to understand if a proposal was feasible,” says Head of Arts at CERN [5.1].

British-Taiwanese artist Yu-Chen Wang was one of the ten artists involved in Collide International. Wang describes how Shears’ mentorship during the CERN residency was critical to her art: “ Without Professor Shears’ expertise and assistance, my understanding of particle physics, the scientific method and the way that researchers collaborate would not have been sufficient to create [my artwork] for Broken Symmetries,” [5.3]. “ Not only did Professor Shears give me a fundamental overview about how we “do” science, but she ensured that the science was always explained to me. I've tried to reflect all of the major points which came out of my conversations with Professor Shears... I think it is a major feature of my work,” says Wang [5.3].

The collaboration also had an impact upon Wang’s creative practice. “ As an artist, I am more open to different approaches and better able to link up different ideas as a result of working with Professor Shears through the Arts at CERN Collide International Award,” says Wang [5.3]. According to the Head of Arts at CERN, Shears’ “ mentorship of artists during the residencies at CERN and in Liverpool was instrumental” in the overall success of the project [5.1].

The resulting art exhibition, ‘Broken Symmetries’, showcased artworks from all ten artists that took part in Collide International. Broken Symmetries premiered at FACT in Liverpool in 2018 and received 73,464 visitors (November 2018 - March 2019), with 15,113 “ deeply engaged gallery visits” [5.2a]. “ The exhibition was a huge critical and audience success,” says FACT’s Head of Development [5.2a]. “ Prof Shears was key in supporting FACT: visiting the Large Hadron Collider with FACT staff and artists; enabling us to better understand the nuances of being a researcher at CERN, so we could best support our residencies; in the selection of artists; and as a guest speaker at public programme events” [5.2a]. According to a FACT report, Broken Symmetries generated significant national attention with 29 pieces of media coverage reaching over 703,000 people, including Financial Times, BBC World Service, and i newspaper [5.2b]. Shears and the partnership “ had a profound relationship on FACT’s experience at working at the intersection of art and science”, says the Head of Development at FACT [5.2a].

Broken Symmetries toured across Europe and Asia, and was attended by 199,996 visitors. It was exhibited at Centre de Cultura Contemporània de Barcelona (CCCB), Spain in 2019 (80,096 visitors), National Taiwan Museum of Fine Arts in Taichung, Taiwan in 2020 (34,146 visitors), iMAL (interactive Media Art Laboratory) in Brussels, Belgium in 2020 (1,490 visitors), and Kumu in Tallinn, Estonia in 2020 (10,800 visitors) [5.1]. The Broken Symmetries exhibition in Barcelona was “ the third most visited exhibition in CCCB’s history” [5.1]. “ We were very impressed about the number of visitors that came to the exhibitions. It was quite extraordinary. We also had a great reception to the exhibition from the Spanish and Belgian media,” says Head of Arts at CERN [5.1]. Throughout the collaboration, Shears took part in public debates [5.1, 5.2a] alongside artists (including Geneva 2016, Liverpool School of Art 2017, FACT 2018) to provide insight into the particle physics concepts behind the art and Liverpool’s LHCb research.

Broken Symmetries built on a successful project in which Shears worked with artists Evelina Domnitch and Dmitri Gelfand to provide insights into particle physics for ‘No Such Thing as Gravity’ - an artwork based on Liverpool’s antimatter research. It was exhibited at FACT in 2016 (15,772 visitors) and the National Taiwan Museum of Fine Arts in 2017 [5.4a]. No Such Thing as Gravity received widespread critical acclaim across national media, with coverage on BBC Radio 3, New Scientist and The Guardian [5.4b]. No Such Thing as Gravity was described by Liverpool Echo as a “ fascinating exhibit on what we think we know about science and its possibilities” and a “ show designed to get non-scientists thinking scientifically” by New Scientist magazine [5.4b].

4.2 Shaped debate and stimulated public interest in particle physics through philosophy

By exploring particle physics concepts through rigorous philosophical debate, Shears opened up Liverpool’s LHCb research to new audiences and shaped public debate. At HowTheLightGetsIn Festival, ‘ the world's largest philosophy and music festival’ hosted by the Institute of Art and Ideas (IAI), Shears has engaged audiences with particle physics concepts from Liverpool’s LHCb research [5.5]. Shears participated in six debates with philosophers (2014, 2015, 2016), and hosted an additional four debates (2015, 2016) on subjects as diverse as whether the universe is mathematical and the role of evidence in science [5.5]. These debates were attended in-person by 3,000 people and received 121,394 views across IAI Player and YouTube [5.5]. The IAI cited two of Shears’ debates in their end of year “best of IAI TV 2016” list [5.5].

To enhance public and cultural understanding of particle physics research, Shears took part in a philosophical debate on BBC Radio 4 (2015) and provided insights from Liverpool’s LHCb research at CERN [5.6]. Hosted by Melvyn Bragg, the debate explored “ How can I know anything at all?” and was commissioned as part of the BBC’s ‘A History of Ideas’ series. The debate is available on-demand via BBC Sounds [5.6]. Shears further explored the importance of the scientific method within Liverpool’s LHCb research on a separate Radio 4 documentary about falsification (2015) which also remains available on-demand via BBC Sounds [5.6]. Based on her Radio 4 documentary on falsification, Shears co-created a short BBC animation about philosopher of science Sir Karl Popper that has been viewed 295,309 times on YouTube [5.6]. Feedback described it as “ enlightening”, “ succinct” and “ beautiful” [5.6]. This animation is showcased by London’s National Portrait Gallery (1.5 million visitors per year) as recommended background visitor information for their portraits of Popper and philosopher Karl Marx [5.7].

4.3 Raised awareness and improved public understanding of Liverpool’s LHCb particle physics research breakthroughs through international press and media coverage

Shears has “ reached audiences of many tens of millions of people” worldwide during the REF period through print, radio and broadcast media interviews that have “ raised awareness and increased public understanding of a number of key LHC research discoveries” [5.8]. These include antimatter (2014-2020) [3.2], LHC Run 2 re-start (2015), lepton universality (2015-2019) [3.3], and pentaquark and baryon discoveries (2017-2019) [3.4,3.5]. “ Prof Shears’ work with journalists and the media allows the research we fund at the LHC to be better understood by our stakeholders and the public,” according to the Co-Head of Communications at STFC [5.8].

During the REF period, Shears has provided quotes used in 12 STFC press releases about major LHCb research stories and has been interviewed by numerous major journalists [5.8], generating 66 unique pieces of high-quality coverage [5.9a] across national and international print, radio and broadcast media. Major mainstream and scientific digital and print media outlets worldwide have covered Shears’ LHCb research and included quotes from her within their coverage, including New Scientist, Nature, Scientific American, Wired (UK, Italy), Engineering and Technology Magazine, Financial Times, the Independent, The Guardian, The Times, Daily Mail, Daily Mirror, Daily Express, and Buzzfeed [5.9a]. Shears “ has a profound understanding of what interests a lay audience,” according to New Scientist’s Creative Director [5.10]. “[Shears] has explained to the public all the outstanding questions that particle physics has to answer and demystified the process of discovery” [5.10].

Shears has also raised awareness and increased public understanding of Liverpool’s latest research results from the LHCb experiment at CERN through radio appearances on RTÉ Radio (Ireland), LBC Radio, BBC Radio 3, BBC Radio 4, and BBC World Service [5.9a], as well as public radio stations in the US, Finland, and Mexico [5.9a]. Through broadcast media appearances, Shears has engaged television audiences with cutting-edge research developments from LHCb, including interviews on BBC Breakfast, BBC News, BBC World, ITV News, and Arte (France), as well as an appearance on a documentary for the Discovery Channel in the US [5.10b]. For STFC’s Co-Head of Communications, “ Shears really helps the public to understand particle physics research at the LHC at a deeper level,” [5.8].

The significance of Shears’ media engagement is highly regarded by journalists, editors, and producers alike, as evidenced by repeat media interviews including, BBC News, The Guardian, BBC World Service and BBC Radio 4 [5.8, 5.9a]. “ For New Scientist journalists, [Shears] is a go-to source because she can explain the physics so clearly and crucially, put it in context” [5.10]. “She has an innate ability to quickly understand what a journalist is interested in, and explain her research to them in a way that they can use to tell a powerful story to their readers and the public,” says STFC’s Co-Head of Communications [5.8]. “ The BBC Science team come back to her time and time again because they find her insight and input incredibly valuable,” [5.8].

Working with the Royal Institution (October 2013 - 2020), Shears co-created and presented six short videos about major LHCb research developments including antimatter [3.2], the Standard Model [3.3], and pentaquarks [3.4], which have been viewed online 877,275 times during the REF period [5.9b]. Shears has also delivered two TED talks in Liverpool and Arendal (2014, 2016) about LHCb research into antimatter [3.2] which have been viewed 374,956 times [5.9b].

As a result of her media work being viewed as exemplary by the scientific press, Shears was approached by Nature (2018) to provide expert advice and best practice on how scientists can interact with journalists successfully [5.9c] and she is cited within STFC media training as an “ exemplar of how to marry up media work alongside continuing to do your research” [5.8]. Shears continues to receive a high number of requests for interviews about particle physics research developments from LHCb. For “ particle physics research at CERN, there are three or four experts in the UK that I always direct journalists to, and Prof Shears is one of them,” according to Co-Head of Communications at STFC who states that she “ *has reached audiences of many tens of millions of people during this period as a result of her STFC media work.*” [5.8].

The University of Liverpool has developed novel silicone oil tamponades that deliver improved treatment of retinal detachments. The products can be injected easily through fine gauge surgical needles, allowing smaller incisions and thereby minimising patient eye trauma. They also possess enhanced resistance to emulsification within the eye, reducing complications including cloudy vision, inflammation, glaucoma and retinal redetachment.

The products are now sold by the University of Liverpool patent licensee Fluoron GmbH in approximately 40 countries and in Europe account for approximately 37% of the silicone oil tamponade market. Since end 2013, products sales globally have generated total revenue of [text removed for publication] with approximately 73,500 patients treated. The impacts reported are on health, wellbeing and the economy.

Product Development

The underpinning research conducted at UoL between March 2005 and July 2008 demonstrated that a silicone oil tamponade possessing a unique combination of rapid injection through fine gauge surgical needles and enhanced resistance to emulsification within the eye could be achieved by addition of a high molecular weight silicone polymer (polydimethylsiloxane – PDMS) to a base silicone (PDMS) oil, thereby addressing a long standing unmet need for such a product in vitreoretinal surgery [3.1 - 3.4]. Additionally, such compositions are chemically identical to conventional oils, greatly simplifying regulatory approval.

The technology is covered by a UoL patent filed in 2006 (WO2006/122973 – “Composition for the treatment of a detached retina and method of production thereof”; Inventors Rachel Williams, Michael Garvey, Michael Day) [3.1]. In December 2005 the technology was licensed exclusively to Fluoron GmbH (Magirus-Deutz-Strasse 10, D-89077 Ulm, Germany; contact Dr Wilfried Kugler), a leading global supplier of silicone oil tamponades, with the company agreeing to pay all future patent costs.

Following technology transfer from the UoL, Siluron 2000 (EC Certification: CE 575554) was launched by Fluoron in Europe in 2008 [5.1; 5.2]. The product has a much lower shear viscosity (approximately 2300mPas) than conventional 5000 silicone oil and (unlike the latter) is shear thinning and so can be injected approximately 3 times as rapidly as 5000 oil whilst possessing similar emulsification resistance [3.2 - 3.4].

This was followed in July 2013 by Siluron Xtra (EC Certification: CE 575554) [5.1; 5.2]. Compared to Siluron 2000, Xtra contains a higher amount of silicone polymer, increasing the extensional viscosity and therefore further enhancing resistance to emulsification [3.2 - 3.4]. The product has a shear viscosity of approximately 4600mPas and (again due to shear thinning) can be injected approximately twice as rapidly as conventional 5000 silicone oil [3.4].

A third product, Densiron Xtra, a “heavy tamponade” tailored specifically for the treatment of retinal detachments in the lower part of the eye, was launched in 2016 [5.2]. This delivers enhanced resistance to emulsification compared to other heavy tamponades (with this product more rapid injection is not advantageous since existing heavy tamponades are already easy to inject).

Economic Impact

The UoL technology is unique and distinguishes Fluoron’s products from those of competitor suppliers of standard silicone oil tamponades. By end 2013, the UoL patent had been granted in Australia, China, Hong Kong and Japan. Since end 2013, the patent has been granted in Canada (2015), the EU (2015) and Turkey (2015) and is currently pending in the USA.

Globally, the annual incidence of retinal detachments is approximately 1 in 10,000 people. In Europe there are approximately 80,000 cases per annum with approximately 20,000 being treated with a silicone oil tamponade. In 2019, combined European sales of Siluron 2000, Siluron Xtra and Densiron Xtra were approximately 7,540, indicating a market share of approximately 37% (5.3]. Globally, between end 2013 and end June 2020, combined sales of the products were 77,224 generating total revenue of [text removed for publication] (compared to total unit sales and revenue between 2008 and end 2013 of 38,736 and [text removed for publication] respectively) [5.3].

Impacts on Health and Wellbeing

The novel products have transformed the treatment of complex retinal detachments by combining the advantages of conventional silicone oil tamponades whilst alleviating the drawbacks, thereby improving patient outcomes. Between end 2013 and end June 2020, approximately 73,500 patients have been treated and therefore benefited from the technology. Testimonials from internationally leading vitreoretinal surgeons evidence benefits to health:

• “The introduction of the oils has in my mind already saved a lot of eyes from complications and costs of treating these complications… I fully endorse the invention and I regard it as one of the UK’s best contributions to the field of vitreoretinal surgery” - Consultant Vitreoretinal Surgeon (Retired), St Paul’s Eye Unit, Royal Liverpool University Hospital [5.4]

• “From a patient perspective emulsification resistance remains the paramount quality of any silicone oil since it is thought that it was precisely the emulsified droplets that give rise to postoperative ocular inflammation, glaucoma and ultimately sight loss. Herein lies the patient benefit in choosing a medical device (silicone oil) with a reduced tendency to emulsify. In essence, it is a better product” - Consultant Vitreoretinal Surgeon, Hospital Ophthalmic Jules-Gonin, Lausanne [5.5]

Prior to this research, surgeons were faced with a choice between ease of injection with a greater risk of emulsification or greater emulsification resistance but with much slower injection, with the trend towards finer gauge surgery often leading surgeons to opt for 1000 oil with the associated greater risk of emulsification-related complications such as impaired vision, inflammation, glaucoma and retinal redetachment. With Siluron 2000 and Siluron Xtra, rapid injection offers shorter operating times and compatibility with finer gauge surgical needles, the latter allowing for smaller surgical incisions, thereby minimising patient eye trauma; enhanced emulsification resistance reduces the risk of patients suffering post-operative complications, thereby reducing the likelihood of further treatment being required and hence reducing costs to (for example) the NHS and improving patient wellbeing. Testimonials from Clinicians within the NHS have described the impact on their practice:

• “Before the launch of Siluron 2000 and Siluron Xtra I was using 1000 centistoke oil but have now switched to Siluron 2000 where I want a light (i.e. buoyant) oil and Densiron Xtra for situations where I want to use a heavy oil… I have found a low incidence of emulsification, significantly improved compared to the previous oils…The ability to inject and extract the oils even with 25 gauge surgery is also much improved compared to high viscosity oils… Siluron 2000 and Siluron Xtra have been major advances for vitreoretinal surgery” - Consultant Ophthalmologist, Sunderland Eye Infirmary [5.6]

• “Vitreoretinal surgeons aim to remove the silicone oil after 3 months because of the risk of emulsification leading to complications with keratopathy, disease of the cornea and glaucoma… in my experience such complications have been much less with Siluron 2000 and Siluron Xtra” - Consultant Vitreoretinal Surgeon, St Paul’s Eye Unit, Royal Liverpool University Hospital [5.7]

The efficacy of the products has been confirmed in reported studies. Stalmans et al (72 patient study, 2015) reported that Siluron 2000 could be injected and removed significantly more rapidly than standard 5000 oil and showed similar emulsification behaviour [5.8]. Hussain et al (28 patients, 2017) concluded that Siluron Xtra “seems to be an acceptable alternative tamponade for the management of complex retinal detachments with comparable anatomical success… to other low viscosity silicone oil agents but more importantly with a lower rate of emulsified oil-related complications” [5.9]. An in-vitro study by Chan et al (2017) reported that Siluron 2000 emulsified less than a viscosity-matched standard 2000 oil and Siluron Xtra emulsified less than standard 5000 oil [5.10].

In summary, the novel silicone oil tamponades have had a significant impact on patient outcomes with health benefits including reduced eye trauma and reduced post-operative complications. In Europe, the products have achieved approximately 37% share of the silicone oil tamponade market. The products have had global reach through sales in approximately 40 countries, generating total revenue of [text removed for publication] and being used to treat approximately 73,500 patients.

Founded on the basis of and underpinned by Liverpool University’s particle physics research and IP, AIMES has generated economic and healthcare impacts since 2014 that include:

• Increased the company’s annual turnover by 96% to £4.5M in 2019/20, significantly exceeding the UK’s national average turnover for small companies, and created 21 new jobs

• Contributed to the improvement of health service design and commissioning through its data centre and deployment of Trustworthy Research Environments (TREs) in 2016

• Delivered improvements for NHS cost and resource efficiency through the use of TREs

4.1 Economic impact of AIMES – increased revenue generation and new job creation

Since its foundation based on and underpinned by Liverpool’s particle physics research, AIMES has developed into an award-winning and industry-leading commercial data centre service provider based in the Liverpool City Region. Securing £1M Development Funding from Santander in May 2018 allowed AIMES to create a new 10,000 sq. ft. Health Informatics Centre at Kilby House Facility in Liverpool [5.1]. The new centre provides state-of-the art digital accommodation, specifically designed for advanced health informatics with connections to the Kilby House data centre and to the new Health and Social Care Network.

The annual turnover of AIMES increased by £2.2M (96%) to £4.5M in 2019/20 from £2.3M in 2014/15 [5.1], underlining the economic impact of AIMES which was founded on the basis of and underpinned by Liverpool’s research. This is an average year-on-year growth of more than 14% [5.1], significantly exceeding the UK’s national average turnover figures for small UK companies with 10-49 employees of £3M per annum, as outlined by the UK government’s Department for Business, Energy & Industrial Strategy (BEIS) in 2019 [5.2]. Between 2014 and 2020, AIMES created 21 new jobs in the Liverpool City Region, bringing its current headcount up to a total of 30 staff employed [5.1]. This represents a significant increase of 70% from 2014 to 2020, and demonstrates the growth and viability of AIMES Grid Services’ business.

4.2 Healthcare impact of TREs – improved health service design and commissioning

In the healthcare sector, when dataflows cross organisational boundaries, including the NHS, social care, universities, police and industry, there is a need for a trustworthy infrastructure to link data while preserving the needs of the data owners, citizens, and researchers. AIMES Grid Services took on the task of addressing this challenge by using research expertise from the Department of Physics’ MAP2 computer to develop the Trustworthy Research Environment (TRE) - a secure platform to analyse data and satisfy common data standards, information governance and legal requirements for the storage and use of data.

In 2016 AIMES Grid Services pioneered the TRE infrastructure in a number of project initiatives in collaboration with industry, the NHS and universities. AIMES’ digital services have had significant impact on improving the design and commissioning of healthcare services in the North of England through the Connected Health Cities programme. Three examples of the impact of TREs on healthcare services (4.2a, 4.2b, 4.2c) are described below.

4.2a The Connected Health Cities programme – “ Healthcare Project of the Year”

AIMES Grid Services was awarded a contract to host the infrastructure for the Connected Health Cities programme to unite regional health data with advanced technology. AIMES used its cloud computing expertise to build two TREs: the North West Coast, and the North East and North Cumbria TREs which enabled local adaptation to governance, data and research requirements [5.3]. The pan-northern Connected Health Cities programme was named “ Healthcare Project of the Year” at the 2018 Bionow Awards [5.4], recognising Connected Health Cities’ innovative use of TRE technology and NHS data in creating and embedding learning health systems across 20 care pathway projects in the North of England. “The key element in selecting the winner was that through bringing together a complex number of partners and organisations, the project has been able to harness and make use of clinical data. It is a project of magnitude and truly connects the North.” - Technology Director at Trustech [5.4].

4.2b Design and commissioning of healthcare services in the North of England

AIMES’ deployment of a TRE with the Connected Health Cities programme was pivotal in improving the design and commissioning of healthcare services in the North of England.

The Great North Care Record created one shared care record for patients. Using the TRE infrastructure, the Great North Care Record now gives care records access to 100% of General Practices across the North East and North Cumbria, involving 400 practices, 25 NHS and Local Authorities, and 12 NHS Clinical Commissioning Groups, saving at least £8M per year [5.3].

By running newly developed algorithms on the TRE infrastructure, an extra 66% of epilepsy-related admissions were identified when compared to just using the primary diagnosis code, capturing more accurate average length of stay [5.3]. An application of these findings enabled paramedics to access epilepsy care records from secondary care to inform decisions about conveyance and immediate care [5.3]. “ By making additional information accessible for our ambulance clinicians, they will be able to make more informed decisions based on the patient’s medical history. This means that if the patient could benefit more from care in the community, unnecessary A&E admissions can be avoided which in turn will free up vital emergency resources.” - Chief Consultant Paramedic, North West Ambulance Service NHS Trust [5.3].

4.2c Detecting cases of Alcohol-Related Liver Disease

The North West region of England has one of the country’s highest rates of alcohol-specific deaths and Alcohol-Related Liver Disease is the dominant cause. Early inpatient intervention has the potential to save lives, however, reports show fewer than half of patients received ‘good care’ and mortality rates are high [5.5]. Using the TRE infrastructure through the Connected Health Cities programme, an extra 40% of cases of Alcohol-Related Liver Disease were detected when compared with standard approaches for capturing data on emergency admissions. The detection of extra cases of Alcohol-Related Liver Disease resulted in improved knowledge of disease burden and better monitoring of inpatient and post-discharge outcomes [5.3]. “ Our goal is to link, analyse and visualise data in ways that reflect the complexities of alcohol-related conditions and the wide variability in local service provision and organisation across the region – bringing local context to the interrogation of data” - Consultant Gastroenterologist at Aintree University Hospital, North Mersey HIS and Connected Health Cities Clinical Lead for Alcohol [5.6].

4.3 Impact of TREs on NHS practice and operations – improved cost and resource efficiency for health services

Current practice in large-scale, multi-centre clinical trials are often wasteful, resulting in significant costs and overheads. Trial protocols, staff records, training and governance information are typically maintained by participant sites in paper form which is not efficient practice within NHS operations. Poor recruitment for clinical trials can not only have financial ramifications, owing to increased time and resources being spent, but can also adversely influence the clinical impact of a study if it becomes underpowered [5.7].

In response to this problem, AIMES and the Liverpool Heart and Chest Hospital NHS Foundation Trust partnered to design and build a secure cloud-based platform, a TRE called “Streamline”, to manage research data capture and document workflows. The benefits of Streamline include: reduced administration costs to keep protocols up to date, increased visibility of the research data for adaptive trial designs, easier data collection for medical professionals, making clinical trials paper-free and guaranteeing failsafe access to current documents and legacy versions, appropriate access from any web-enabled device, allowing remote-view and monitoring of research governance, for cost efficiency and assurance.

Streamline enabled a reduction of almost 50% in the time taken to recruit patients into cardiac clinical trial programmes at the Liverpool Heart and Chest Hospital NHS Foundation Trust. When first deployed, a three-year recruitment target was met within 18 months [5.1]. “The online trial system is a sea-change in trial governance. It relieves individual trial staff of the burden of site file management and provides many useful tools to the system administrators” - Research IT and Systems Lead at the Liverpool Heart and Chest Hospital NHS Foundation Trust [5.7].

Having worked together in the deployment and implementation of TREs, the partnership between AIMES Grid Services and the Liverpool Heart and Chest Hospital NHS Foundation Trust was one of the three finalists for the “ Best Industry Partnership” award at the North West Coast Research & Innovation Awards 2017 [5.8], recognising the significant impact of their partnership on cost and resource efficiencies in the provision of healthcare services for the NHS.